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Oh woe, my toe!

Today’s post is about an ailment, namely gout. Why? Because I discovered some months ago that Edward I, a larger-than-life presence in my upcoming rlease, apparently suffered from this disease. Now, In Sweden gout has pejoratively been known as “portvinstå” – portwinetoe – and was assumed to afflict only very sedentary, very rich, somewhat obese, very lazy older men. Okay, so Edward is an older man in 1294. And yes, he is also rich. But he is neither obese, sedentary or lazy, which just goes to prove that gout – like so many other ailments – comes with preconceived and often mistaken views on those afflicted.

Deffo a “portwinetoe” dude – by James Gillray

For about as long as humans have lived in civilisations—complex structures that allow some to become top dogs while the others remain as bottom feeders, gout has been a recurring affliction. Why? Because it is essentially a life-style disease. Eat too much red meat, drink too much beer and wine and you may potentially end up with a gouty joint. Edward I was deffo a top dog. And he also seems to have enjoyed both wine and meat. But it is not that simple: gout is likely also a consequence of your genes as it is a form of arthritis.

Gout is caused by excess uric acid in the blood, leading to, swelling, acute pain and redness. Essentially, the uric acid forms miniature crystals that happily converge on the closest joint. Sometimes, gout is chronic, causing permanent damage to the joints. These days, there is medication available that can alleviate the symptoms. Not so back in the foggy days of distant history.

Already the old Egyptians were familiar with the disease, and a couple of millennia later, in the 5th century BC or so, Hippocrates called it the “unwalkable disease”. Anyone who has experienced the burning pain of a gouty toe would likely agree with him . . .

By then (i.e. when Hippocrates was around), gout was known as podraga, and that name would stick. Romans had it—Seneca commented on the fact that even women could get it, adding a rather snarky comment that it was no wonder, given just how lecherous these modern women could be. Mostly, though, gout has been a male affliction.

Alexander the Great apparently had gout. Seeing as this splendorous dude died in his thirties, one wonders just how much meat and wine he consumed on a daily basis…

Charlemagne was another fellow sufferer, and now we are approaching the medieval period, when everyone knew podraga was the consequence of an imbalance in your humours. Duh! If the four humours governing your health (blood, yellow bile, black bile and phlegm) weren’t adequately balanced a drop or two of the humour in excess could slither down your veins and settle in your joint, hence the inflammation. This theory is also the background to the term gout, as Latin for “drop” is “gutta”, and in the late twelfth century a Dominican monk named Randolphus of Bocking working for the Bishop of Chichester is credited with having shortened the rather cumbersome “gutta quam podagram vel artiticam vocant” (the drop that causes podraga or arthritis) into “gutta” which became gout.

As mentioned above, another sufferer was Edward I. In Their Castilian Orphan (released March 2024) his aching toe causes his mood to blacken frequently—and it doesn’t help that on top of his toe he has to handle that deceitful bastard, the king of France, and a Welsh rebellion. However, by 1294 the physicians of the time had discovered a substance that helped with gout, namely colchicine, the toxin in autumn crocuses.

Autumn Crocus

This is where I just have to go a bit tangential: How did they discover it helped with gout? Did they first try to ingest it (bad, bad idea as it is very poisonous)? Or was it just a case of a desperate physician rushing outside to escape the raging of his angry, hurting patient and stumbled upon a stand of autumn crocuses, thinking “well, at least they’re pretty to look at”, before grabbing a bunch and pulverising them into a salve that, lo and behold, helped? Well we will never know, will we?

King Eward, however, benefited from this leading-edge medicinal knowledge, and one of his pages regularly doctored his aching toe.  By medieval times, physicians were also quite convinced it helped to change your diet to minimise the discomfort caused by gout. Not that the advice was always well-received . . .

Once in London, Lionel and his fellow pages saw little of the king—the man was in one meeting after the other, most of them ensconced with trusted men like St John or his brother. But every evening, Lionel was ordered to minister to the king’s toe, and at present it was a raw and hurting thing that even, on occasion, required the physician himself to attend on the king.

“Less wine, less meat, my liege,” the physician suggested.

“Less wine?” With a truculent look that reminded Lionel of Issy at her most stubborn, the king sloshed more wine into his goblet. “And how, pray, do you think I will hold on to my sanity in these trying times without this comfort?”

The physician held up his hands. “I am merely offering medical advice, my liege.”


Moments later, the goblet went flying, crashing against the distant wall. “Fine, less wine,” the king growled, heaved himself upright and stalked off towards his bed. “Clean that up before you leave,” he barked at Lionel, who ducked his head to hide the tears filling his eyes. He had no notion what he had done, but of late the king was always taking out his anger on him.

“Here, lad.” The physician crouched beside him and handed him a cloth. “It’s the pain,” he added in a whisper. “For a man so used to being nigh on invincible, it is as crippling mentally as physically.”

Lionel nodded as if he understood, but truth be, he did not.

Another English king who suffered from gout is Henry VIII. No wonder, I say, seeing as the man ended up almost as broad as he was tall (and he was very tall) Just like Edward, he tended to take out his pain on whoever was close enough.

Charlex V and his wife, Isabella. By Tizian

A contemporary to Henry VIII is Charles, the Hapsburg emperor. Not exactly Henry’s favourite person, what with Charles exerting his considerable influence at the papal court to stop Henry’s much desired divorce from Katherine of Aragon to go through. Katherine was Charles’ aunt, and blood is always very, very thick when we’re talking Hapsburgs—so thick, in fact, that for centuries they preferred to marry close relatives. (Charles himself married his first cousin, and his son, Philip, married a woman who was his first cousin on both sides…)

Anyway: Emperor Charles was also a fellow gout sufferer—confirmed by examining his finger in 2006—and on one occasion, his affliction was to cost him an entire city. Already in the 1500s, France and the Hapsburg Empire were at constant loggerheads—France did not like it, that another power rose to be the foremost, most Catholic entity of all. (yes, yes, a simplification) In 1552, the French attacked Metz—and managed to take it. Charles gnashed his teeth, enraged, but was almost paralysed with pain on account of his gout, so he had no choice but to retreat and leave Metz in French hands. Instead, Charles decided it was time to abdicate and leave the ruling to someone as yet unafflicted by gout—and age in general.

Charles V being carried around due to gout

Leaping forward, I just have to mention that Isaac Newton suffered from gout. So did Benjamin Franklin—and Thomas Jefferson. Franklin had a personal relationship with “his” gout, as illustrated by this rather sweet conversation between Mr Franklin and Madame Gout.

Other famous goutees are Christofer Columbus, Michelangelo, Leonardo da Vinci, Beethoven, Queen Victoria and Karl Marx—to mention a few. Even my favourite Swedish king, Gustav II Adolf had gout, so badly at times he was carried in a litter from one battlefield to the other.

In this day and age, gout is still a thriving disease—in fact, the number of people afflicted is increasing, partly due to there simply being more people on this planet of ours, partly due to the fact that more and more of us can afford to eat like the kings of old. Not a smart thing to do, IMO, as those kings of old rarely bothered with kale and salads and low-fat dairy products.

Ouch! “Gout” by James Gillray

An acquaintance of mine was recently flying across the Atlantic when he was suddenly afflicted by the pains of all pains in his toe. Unbearable. Agonising.
“Huh,” I was tempted to say. “You’ve never given birth, have you?”
Still, his vivid description of his pain made me wince. Once back home, he contacted a doctor who told him it was. . . wait for it . . . gout. My acquaintance ended up on a strict diet. No meat of any sort, no white bread, veggies, veggies, veggies. A couple of weeks later, there was no pain. But gout is a nefarious disease, which means the moment you skip the diet, it may very well pop up and bite you—painfully!

To all those out there who suffer from gout, I send a warm, warm hug. It may offer some comfort to realise just how many geniuses and powerful peeps have been fellow sufferers–or so I hope!


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